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Though medical education is not inexpensive, academic leaders often ignore the fact that the funds to support it properly are already available, if they choose to use the funds for this purpose. Student tuition, appropriations from state legislature to public schools, and certain portions of endowment income have always been intended for the education of medical students. Traditionally, deans have appropriated these funds for purposes not directly related to education – an animal care facility here, the establishment of a new research program there. Academic leaders bemoan the lack of funds to support faculty teaching time, even as they spend tens of millions of dollars to build new “teaching and learning centers” or expand the administrative bureaucracy.

The real problem is that higher education isn’t providing enough of a benefit to its graduates, not that universities aren’t extracting enough money from the students. But read the whole thing. Including this: “And, of course, while professors are expensive, they’re not the main expense. Administrators outnumber faculty at most universities these days. But I suspect that won’t get the scrutiny it deserves.” Speaking of cost centers. Much more on administrative bloat, here.

None of this is exactly new knowledge. The response, however, has been as slow as, well, bureaucratic molasses.

3 Responses to “Food for thought”

Medical school teaching was far better in the days when full time faculties were small at most medical schools and a lot of the teaching was done by unpaid volunteers. In my medical school, U of Southern California, there was a tradition of voluntary faculty in surgery. The chief from 1932 to 1969, CJ Berne, was part time and donated his salary to the school, as did the chief of Pathology, Hugh Edmondson who was full time but wealthy. The surgery department had three full time members at the time I went through training. I also spent six months at the Mass General as a medical student and most of the teaching there was by the likes of Claude Welch and Marsh Bartlett, both of whom were full time practitioners in the private wards.

Now the USC surgery department has 90 full time members and, about 20 years ago, the part time people were told they were no longer needed. Interestingly enough, during my era at USC only one graduate failed the boards and he was never allowed to forget it. About ten years ago, they had about one-third failing the boards on the first try.

The worst administrative bloat is at K -12 programs like the LA Unified School District. I understand administrative personnel far outnumber teachers by something like 3 to 1.

When universities and other non-profits apply for government research funding they include a
Federally Approved Administrative Rate to these requests. These rates approach 45%. It means that when Stanford, Johns Hopkins and others receive $400 million and more, almost half goes to
administrative and general operating expenses. If you lower those rates more funding will go
to teachers and researchers and not to an over-bloated administration.

MK: Teaching today is often done by busy and harried physicians that are asked to see an increasing volume of patients in order to keep their salaries stable. The day being 24 hours, something is going to give. Either you devote more time to your patients, or to your students. You can’t do it all. The way around this has been to start a clinical “track” and reward physicians financially for teaching a set number of hours or for a set number of duties.

Either way, people seem busier and busier and the product uncertain.

PTL: That’s a good point. How the admin money is spent can be more or less productive, too. Take someone that helps doctors enter and manage research data versus, I dunno, a marketing administrator. I’m not knocking marketing, people, I’m just trying to make a point about the effective use of monies! :)